| Change in blood-brain barrier permeability during pediatric diabetic ketoacidosis treatment. | |
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MedLine Citation:
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PMID: 19838141 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Cerebral edema is a devastating complication of pediatric diabetic ketoacidosis. We aimed to examine blood-brain barrier permeability during treatment of diabetic ketoacidosis in children. DESIGN: Prospective observational study. SETTING: Seattle Children's Hospital, Seattle, WA. PATIENTS: Children admitted with diabetic ketoacidosis (pH <7.3, HCO3 <15 mEq/L, glucose >300 mg/dL, and ketosis). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Subjects underwent two serial paired contrast-enhanced perfusion (gadolinium) and diffusion magnetic resonance imaging scans. Change in whole brain and regional blood-brain barrier permeability (permeability ratio*100 and % permeability ratio change) between illness and recovery were determined. Time 0 reflects start of insulin treatment. Thirteen children (median age 10.0 +/- 1.1 yrs; seven female) with diabetic ketoacidosis were enrolled. Permeability ratio increased from time 1 (first magnetic resonance image after time 0) to time 2 (second magnetic resonance image after time 0) in the frontal cortex (ten of 13 subjects), occipital cortex (ten of 13 subjects), and basal ganglia (nine of 13). Whole brain permeability ratio increased from time 1 to time 2 (160%) and regional increase in permeability ratio was greatest in the frontal cortex (148%) compared with the occipital cortex (128%) and basal ganglia (112%). CONCLUSIONS: Overall, whole brain and regional blood-brain barrier permeability increased in most subjects during diabetic ketoacidosis treatment. The frontal region had more blood-brain barrier permeability than other brain regions examined. |
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Authors:
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Monica S Vavilala; Todd L Richards; Joan S Roberts; Harvey Chiu; Catherine Pihoker; Heidi Bradford; Kristina Deeter; Ken I Marro; Dennis Shaw |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Volume: 11 ISSN: 1529-7535 ISO Abbreviation: Pediatr Crit Care Med Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-10 Completed Date: 2010-09-08 Revised Date: 2010-09-28 |
Medline Journal Info:
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Nlm Unique ID: 100954653 Medline TA: Pediatr Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 332-8 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, University of Washington, Seattle, WA, USA. Vavilala@u.washington.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Blood-Brain Barrier / metabolism*, physiopathology* Brain / blood supply* Brain Edema / physiopathology Child Diabetic Ketoacidosis / complications, drug therapy* Female Hospitals, Pediatric Humans Hypoglycemic Agents / therapeutic use Insulin / therapeutic use Male Permeability Prospective Studies |
| Grant Support | |
ID/Acronym/Agency:
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R21 EB009438-01A1/EB/NIBIB NIH HHS; R21 EB009438-02/EB/NIBIB NIH HHS; R21 HD049832-01/HD/NICHD NIH HHS; R21-HD044632/HD/NICHD NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Hypoglycemic Agents; 11061-68-0/Insulin |
| Comments/Corrections | |
Comment In:
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Pediatr Crit Care Med. 2010 May;11(3):421-3
[PMID:
20453613
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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